Indicator-based public health monitoring in old age in OECD member countries: a scoping review

BACKGROUND

The scoping review was conducted as part of the project "Improving Health Monitoring in Old Age" (IMOA) which aims at developing a conceptual framework with key indicators for a public health monitoring of the population aged 65 years and older in Germany. We systematically identified indicator-based monitoring systems that focus on health and wellbeing of older populations in member countries of the Organisation for Economic Co-operation and Development (OECD) and analysed them with regard to structure, development and content.

METHODS

A systematic search strategy included searching the websites of national public health institutes, an additional internet search and a MEDLINE search via PubMed. Indicator systems were included if they presented data on a national level, if they were published or updated after 01/01/2007, if they relied on more than one data source and if they were available in English or German. Data on the structure and development of the indicator sets were extracted using a standardized documentation form, and a content analysis of the indicators was conducted using a pre-defined conceptual framework with three health areas and 11 health domains that is based on the Worlds Health Organization's "World Report on Ageing and Health" and on the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Ten indicator-based monitoring systems met our inclusion criteria. Of these, six systems focused exclusively on older populations, and four offer a specific subset of indicators for older age. The number of indicators varied between 22 and 53 (median 32.5). Four systems were directly related to national public health or healthy ageing strategies, and two systems had been developed in consensus processes involving multiple stakeholders. The highest numbers of indicators could be assigned to the domains "health care", "nursing and community care", "wealth and poverty" and "physical health". Overall, 47 different concepts could be identified in the monitoring systems.

CONCLUSION

Among indicator-based monitoring systems of health in older age identified in member countries of the OECD, there is considerable variation with regard to structure, development and content. The results will inspire the development of a public health monitoring of the older population in Germany.

Does breastfeeding help to reduce the risk of childhood overweight and obesity? A propensity score analysis of data from the KiGGS study

BACKGROUND

Current studies suggest that the beneficial effect of breastfeeding on overweight and obesity may have been largely overestimated. We examined the relationship between >4 months of full breastfeeding and overweight/obesity in children living in Germany.

METHODS

We analyzed retrospectively collected data on breastfeeding from children aged 3-17 years who participated in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS baseline study) between 2003 and 2006 (n = 13163). To minimize confounding, we applied propensity score matching and multivariate logistic regression analyses to estimate the effect of breastfeeding on childhood overweight and obesity.

RESULTS

Adjusted analyses of the matched dataset (n = 8034) indicated that children who were breastfed for >4 months had a significant reduction in the odds of overweight (OR 0.81 [95% CI 0.71–0.92]) and obesity (OR 0.75 [95% CI 0.61–0.92]) compared to children who were not breastfed or who were breastfed for a shorter duration [corrected].Further analyses stratified by age group showed that the association was strongest in children aged 7-10 years (OR 0.67 [95% CI 0.53-0.84] for overweight and OR 0.56 [95% CI 0.39-0.81] for obesity), while no significant effect could be seen in other age groups.

DISCUSSION

Our findings support the hypothesis that breastfeeding does have a beneficial effect on childhood overweight and obesity, although the effect seems to be strongest in children of primary school age.

Influence of acute complications on outcome 3 months after ischemic stroke

BACKGROUND

Early medical complications are potentially modifiable factors influencing in-hospital outcome. We investigated the influence of acute complications on mortality and poor outcome 3 months after ischemic stroke.

METHODS

Data were obtained from patients admitted to one of 13 stroke units of the Berlin Stroke Registry (BSR) who participated in a 3-months-follow up between June 2010 and September 2012. We examined the influence of the cumulative number of early in-hospital complications on mortality and poor outcome (death, disability or institutionalization) 3 months after stroke using multivariable logistic regression analyses and calculated attributable fractions to determine the impact of early complications on mortality and poor outcome.

RESULTS

A total of 2349 ischemic stroke patients alive at discharge from acute care were included in the analysis. Older age, stroke severity, pre-stroke dependency and early complications were independent predictors of mortality 3 months after stroke. Poor outcome was independently associated with older age, stroke severity, pre-stroke dependency, previous stroke and early complications. More than 60% of deaths and poor outcomes were attributed to age, pre-stroke dependency and stroke severity and in-hospital complications contributed to 12.3% of deaths and 9.1% of poor outcomes 3 months after stroke.

CONCLUSION

The majority of deaths and poor outcomes after stroke were attributed to non-modifiable factors. However, early in-hospital complications significantly affect outcome in patients who survived the acute phase after stroke, underlining the need to improve prevention and treatment of complications in hospital.

Effective and ineffective college clinical supervisors: looking back

The composite of the effective supervisor is that of an individual who is a knowledgeable professional who puts priority on high-quality instruction and guidance and gives specific, constructive evaluations to supervisees. The effective supervisor is a consistent observer who is accessible, enthusiastic, encouraging, a good listener, and humanistic. This supervisor is knowledgeable about the clients for whom the students are providing services, interacts with them, and demonstrates techniques for students. The supervisor has high expectations of the supervisees, while giving the students responsibility for decisions and input into the therapeutic process. Additionally, the effective supervisor shows interest in and respect for supervisees and guides them toward additional resources for information. The composite of the ineffective supervisor is opposite that of the effective supervisor. This individual is neither knowledgeable nor professional. Quality of instruction and guidance are not priorities for this often self-centered individual. The ineffective supervisor does not observe the students, and what little feedback is given is perceived by the students as negative and detrimental to instruction. This individual does not care about the students or clients who receive services.

Developing the art of successful clinical supervision in health care programs

Supervision is a dynamic and ever-changing process. Excellent employees can be trained to be outstanding supervisors if the competencies and skills of the supervisory process are clarified. Supervision is a successful art that can be learned and enhanced if appropriate supervisory skills are identified, taught, and learned. Supervision is too important in developing the future health care work force to be left to chance.